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Nurse Case Managers and the New Mexico workers' compensation case

Should an injured worker agree to have a nurse case manager on the workers' compensation case?

Often a workers' compensation insurer wants to assign a nurse case manager to a workers' case. You do not have to agree to have a nurse case manager assigned to your workers' compensation case.

The nurse case manager is supposed to assist the worker in getting medical treatment for his or her work injuries. This can include setting up appointments, facilitating referrals, helping with billing issues, and answering the worker's questions about treatment. Sometimes, however, a nurse case manager can interfere with treatment and even undermine it.

I'm often asked by clients and prospective clients if they should agree to have a nurse case manager assigned to their cases or agree to have the nurse case manager continue on their cases. I use the following to decide:

  1. Does the worker need the assistance of a nurse case manager to get medical care for his or her worker injuries? If not, then there should not be a nurse case manager on the case.
  2. Is the medical treatment complicated? If so, AND the worker cannot manage such complicated treatment, then a nurse case manager may be appropriate. This is especially true if there are numerous doctors and health care providers.
  3. Are the worker's injuries very serious? If so, then a nurse case manager may be appropriate because the treatment will likely be complicated and involve numerous doctors and healthcare providers. 

If you have agreed to a nurse case manager on your workers' compensation case, you must confirm that the the nurse case manager understands that he or she is not allowed to speak to any doctors or other healthcare providers. This agreement should be in writing from you. If you discover that the nurse case manager is speaking to your doctors or other healthcare providers, you probably should withdraw your consent to have a nurse case manager on your case.

Once a worker's medical treatment is completed or has lessened, the nurse case manager should be taken off of the case.

In conclusion, nurse case managers can be helpful to workers, especially when there are serious injuries requiring complicated medical treatment. However, you don't have to agree to them. If you do, you must monitor what the nurse case manager is doing and if you discover that that person is no longer helping you, you should have the nurse case manager removed from your workers' compensation case.

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Attorney Robert Scott is committed to answering your questions about workers' compensation, employment law, wage theft, personal injury, and wrongful death law issues in Albuquerque.

I offer a free consultation and I'll gladly discuss your case with you at your convenience. Contact me today to schedule an appointment.